Medical care and long-term treatment of patients with schizophrenia: ethical concerns

Despite the improvement in mental health care that has occurred in the last decades, the mortality risk in patients with schizophrenia has not been changed, and there was even an increase in the mortality of these patients when compared to the general population. The main causes for this increased mortality are somatic diseases, especially diabetes, hypercholesterolemia, hypertrygliceridemia, cardiovascular diseases (including arterial hypertension), obesity, HIV infection/AIDS, hepatitis C and osteoporosis [1]. The link between second generation antipsychotics and cardiovascular risk factors has raised questions on their overall safety, and these concerns are even more important if patients are on compulsory treatment. Furthermore, at least half of patients suffering from schizophrenia have one co-morbidity not diagnosed or wrongly diagnosed [2]. In a sample of 476 community patients suffering from schizophrenia, we found rates of diagnosed hypertension of 6,9%, hypercholesterolemia of 9,0%, hypertrigliceridemia of 6,3%, and diabetes of 4,2%. Not only these figures are lower than in other large studies, but also apparently only 12 to 30% of the patients presenting these disorders were being treated for these conditions [3]. Barriers to recognition and management of physical diseases in patients with schizophrenia are related both to health care providers and to patient/disease. Acute admission could be a target for the screening and treatment of these disorders, and we tried to find a screening protocol for this situation. Acutely ill patients have higher rates of infections and liver abnormalities, but lower rates of hypercholesterolemia [4]. In our sample more than 80% of patients with schizophrenia are retired or unemployed. Resources are scarce, and their allocation to these patients can prevent the access of people suffering from other disorders to the care they need.